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Multicenter Study
. 2025 Feb 6;29(1):65.
doi: 10.1186/s13054-025-05277-y.

Potent P2Y12 inhibitors in patients with acute myocardial infarction and cardiogenic shock

Jinhwan Jo #  1 , Seung Hun Lee #  2 , Hyun Sung Joh  3 , Hyun Kuk Kim  4 , Ju Han Kim  2 , Young Joon Hong  2 , Young Keun Ahn  2 , Myung Ho Jeong  2 , Seung Ho Hur  5 , Doo-Il Kim  6 , Kiyuk Chang  7 , Hun Sik Park  8 , Jang-Whan Bae  9 , Jin-Ok Jeong  10 , Yong Hwan Park  11 , Kyeong Ho Yun  12 , Chang-Hwan Yoon  13 , Yisik Kim  14 , Jin-Yong Hwang  15 , Hyo-Soo Kim  16 , Woochan Kwon  17 , Doosup Shin  18 , Junho Ha  1 , Chang Hoon Kim  1 , Ki Hong Choi  1 , Taek Kyu Park  1 , Jeong Hoon Yang  1 , Young Bin Song  1 , Joo-Yong Hahn  1 , Seung-Hyuk Choi  1 , Hyeon-Cheol Gwon  1 , Joo Myung Lee  19 ; KAMIR Investigators
Affiliations
Multicenter Study

Potent P2Y12 inhibitors in patients with acute myocardial infarction and cardiogenic shock

Jinhwan Jo et al. Crit Care. .

Abstract

Background: Although potent P2Y12 inhibitors, such as ticagrelor and prasugrel, are standard treatment in patients with acute myocardial infarction (AMI), evidence for their efficacy and safety compared with clopidogrel is limited in patients with AMI complicated by cardiogenic shock.

Methods: Among 28,949 patients from the nationwide pooled registry of KAMIR-NIH and KAMIR-V, a total of 1482 patients (5.1%) with AMI and cardiogenic shock who underwent percutaneous coronary intervention of the culprit vessel were selected. Primary outcome was major adverse cardiovascular event (MACE, a composite of cardiac death, MI, repeat revascularization and definite stent thrombosis) and major secondary outcome was Bleeding Academic Research Consortium (BARC) type 2 or greater bleeding at 2 years.

Results: Among the study population, 537 patients (36.2%) received potent P2Y12 inhibitors and 945 patients (63.8%) received clopidogrel after index procedure. The risk of MACE was significantly lower in the potent P2Y12 inhibitors group than in the clopidogrel group (16.6% versus 24.7%; adjusted hazard ratio [HR], 0.76 [95% CI 0.59-0.99]; P = 0.046). Regarding BARC type 2 or greater bleeding, there was no significant difference between the potent P2Y12 inhibitors group and the clopidogrel group (12.5% versus 10.7%; adjusted HR, 1.36 [95% CI 0.98-1.88]; P = 0.064). Significant interaction was observed in patients aged ≥ 75 years (interaction P = 0.021) or venoarterial extracorporeal membrane oxygenator (VA-ECMO) use (interaction P = 0.015) for significantly increased risk of BARC type 2 or greater bleeding following the use of potent P2Y12 inhibitors.

Conclusions: In patients with AMI complicated by cardiogenic shock, the use of potent P2Y12 inhibitors was associated with a lower risk of MACE compared with clopidogrel, without an increased risk of BARC type 2 or greater bleeding. The current data supports the use of potent P2Y12 inhibitors in patients with AMI and cardiogenic shock, except in patients aged ≥ 75 years or receiving VA-ECMO support.

Keywords: Acute myocardial infarction; Bleeding; Cardiogenic shock; Major cardiovascular event; P2Y12 inhibitors.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The protocol of the KAMIR-NIH and KAMIR-V registries were approved by the ethics committee at each participating center, and all patients provided written informed consent. The registry protocols were conducted according to the principles of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: Dr. Seung Hun Lee received an Institutional Research Grant from Abbott Vascular and Boston Scientific. Prof. Joo-Yong Hahn received an Institutional Research Grant from National Evidence-based Healthcare Collaborating Agency, Ministry of Health & Welfare, Korea, Abbott Vascular, Biosensors, Boston Scientific, Daiichi Sankyo, Donga-ST, Hanmi Pharmaceutical, and Medtronic Inc. Prof. Hyeon-Cheol Gwon received an Institutional Research Grant from Boston Scientific, Genoss, and Medtronic Inc. Dr. Joo Myung Lee received an Institutional Research Grant from Abbott Vascular, Boston Scientific, Philips Volcano, Terumo Corporation, Zoll Medical, Donga-ST, and Yuhan Pharmaceutical. All other authors declare that there are no competing interests to declare.

Figures

Fig. 1
Fig. 1
Study Flow. The study population was derived from the nationwide, multicenter, prospective KAMIR-NIH (Korea Acute Myocardial Infarction Registry-National Institute of Health) and KAMIR-V (Korea Acute Myocardial Infarction Registry-V) registries. Abbreviations: BARC, Bleeding Academic Research Consortium; MI, myocardial infarction
Fig. 2
Fig. 2
Primary and Major Secondary Outcomes in AMI patients with Cardiogenic Shock According to Use of Potent P2Y12 Inhibitors. Kaplan–Meier curves with cumulative incidence of (A) MACE and (B) BARC type 2 or greater bleeding according to use of potent P2Y12 inhibitors are shown. Abbreviations: AMI, acute myocardial infarction; BARC, Bleeding Academic Research Consortium; CI, confidence interval; HR, hazard ratio; MACE, major adverse cardiovascular events
Fig. 3
Fig. 3
Primary and Major Secondary Outcomes in AMI patients with Cardiogenic Shock According to Use of Potent P2Y12 Inhibitors Among Propensity Score-Matched Population. Kaplan–Meier curves with cumulative incidence of (A) MACE and (B) BARC type 2 or greater bleeding according to use of potent P2Y12 inhibitors among propensity score-matched populations are shown. Abbreviations: AMI, acute myocardial infarction; BARC, Bleeding Academic Research Consortium; CI, confidence interval; HR, hazard ratio; MACE, major adverse cardiovascular events
Fig. 4
Fig. 4
Subgroup Analysis Regarding Primary and Major Secondary Outcomes. The effects of potent P2Y12 inhibitors on the risk of (A) MACE and (B) BARC type 2 or greater bleeding are shown across various subgroups. Abbreviations: BARC, Bleeding Academic Research Consortium; CI, confidence interval; NSTEMI, non-ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction; VA-ECMO, venoarterial extracorporeal membrane oxygenation
See this image and copyright information in PMC

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